Cardiovascular disease causes 40%-50% of deaths in chronic kidney disease. Omega-3 polyunsaturated fatty acids have pleiotropic cardiovascular effects including anti-inflammatory, antiarrhythmic, and lipid-modulating properties. The landmark Prevention of Cardiovascular Events in End-Stage Renal Disease (PISCES) trial demonstrated a striking 43% reduction in serious cardiovascular events with high-dose fish oil (4 g/day eicosapentaenoic acid + docosahexaenoic acid) in 1228 hemodialysis patients, contrasting sharply with neutral findings from contemporary general population trials (VITamin D and OmegA-3 TriaL (VITAL), the Long-Term Outcomes Study to Assess Statin Residual Risk with Epanova in High Cardiovascular Risk Patients with Hypertriglyceridemia (STRENGTH) and Omega-3 Fatty acids in Elderly with Myocardial Infarction (OMEMI). This paradigm shift suggests hemodialysis patients represent a unique population benefiting fromomega-3 supplementation, potentially due to heightened inflammation, atherogenic dyslipidemia, and uraemia-specific cardiovascular pathophysiology. This opinion article examines PISCES findings, explores mechanisms underlying popu lation-specific responses, discusses implications for clinical practice, and identifies knowledge gaps requiring confirma tory trials. Cite this article as: Mathew GG. Fish oil supplementation and cardiovascular mortality in chronic kidney disease: A paradigm shift from the PISCES trial. Turk J Nephrol. 2026;35(2):158-162.
Gerry George Mathew (Wed,) studied this question.